Intrauterine device with retrieval thread

ABSTRACT

An intrauterine contraceptive system may include a contraceptive intrauterine device, a retrieval thread permanently attached to the intrauterine device and an insertion device for inserting the intrauterine device into a uterus. The system may also include a release thread releasably coupled with the intrauterine device. The intrauterine device may be deployable out of a distal end of the insertion device and may be configured to change from a delivery configuration when housed in the insertion device to a deployed configuration when deployed in a uterus. The retrieval thread and the optional release thread may be at least partially housed within the insertion device during insertion of the intrauterine device into the uterus. The release thread may extend from the intrauterine device through the insertion device to an attachment point at or near a proximal end of the insertion device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 15/477,189, filed Apr. 3, 2017, and issued on Sep.3, 2019, as U.S. Pat. No. 10,398,588, which is a continuationapplication of U.S. patent application Ser. No. 14/794,274, filed Jul.8, 2015, and issued on Apr. 4, 2017, as U.S. Pat. No. 9,610,191, whichis a divisional application of U.S. patent application Ser. No.14/057,297, filed Oct. 18, 2013, and issued on Nov. 10, 2015, as U.S.Pat. No. 9,180,040. The disclosures of the above referenced patentapplications are hereby fully incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to medical devices. More specifically, theinvention relates to intrauterine devices for contraception.

BACKGROUND

An intrauterine device (IUD) is a small, often T-shaped device,containing copper or hormone (e.g., Levonorgestrel), which is insertedinto the uterus to provide long-acting, reversible contraception.Intrauterine devices are the most widely used form of reversiblecontraception, with more than 180 million users worldwide.

Copper IUDs primarily work by disrupting sperm mobility and damagingsperm so that the sperm are prevented from joining with an egg. Copperacts as a spermicide within the uterus, increasing levels of copperions, prostaglandins, and white blood cells within the uterine and tubalfluids. The increased copper ions in the cervical mucus inhibit thesperm's motility and viability, preventing sperm from traveling throughthe cervical mucus or destroying it as it passes through. Copper IUDshave a first-year pregnancy-prevention success rate ranging from 97.8 to99.9 percent. The Paragard® intrauterine copper contraceptive device(www.paragard.com) is currently the most common copper IUD. Copper IUDscan typically be implanted for up to 10 years.

Advantages of the copper IUD include its ability to provide emergencycontraception up to five days after unprotected sex. It is generallyknown as the most effective form of emergency contraception available.It contains no hormones, so it can be used while breast feeding, andfertility returns quickly after removal. Copper IUDs are also availablein a wider range of sizes and shapes than hormonal IUDs. Disadvantagesinclude the possibility of heavier menstrual periods and more painfulmenstrual cramping.

A hormonal IUD, such as the Mirena® levonorgestrel-releasingintrauterine system (www.mirena-us.com), uses the controlled release ofa hormonal contraceptive such as levonorgestrel (a progestin). Thehormonal contraceptive released from a hormonal IUD prevents ovulationfrom occurring, so an egg is never released. The hormone also thickensthe cervical mucus so that sperm cannot reach the fallopian tubes.Hormonal IUDs can be implanted for up to 5 years.

Hormonal IUDs do not increase bleeding as copper-containing IUDs do.Instead, they can often reduce menstrual bleeding or preventmenstruation altogether, and thus they are sometimes used as a treatmentfor menorrhagia (heavy menstrual bleeding). Hormonal IUDs do have commonside effects, however. The most common side effects with levonorgestrelIUDs are hormone-related effects, such as headaches, nausea, breasttenderness, depression and cyst formation.

Regardless of the contraceptive mechanism, IUDs almost always includeone or two threads, which are attached at the distal (cervical) end ofthe IUD, and which have two uses. First, the IUD thread is used toremove the IUD when desired, by the physician pulling on the thread todislodge the IUD from the uterus and pull it through the cervix and outthe vaginal cavity. For this purpose, the thread must be long enough totraverse the cervical canal and extend into the vaginal cavity. Second,the thread is used to confirm that the IUD is still in place. This isdone either by the physician on vaginal exam or by the women herselffeeling the thread with her finger. Third, the thread is currently usedto load the IUD into the IUD insertion device and secure it within theinserter during advancement of the distal end of the inserter into theuterus. Because the thread is used for loading and securing the IUD inthe inserter, it must be long enough to extend through the inserter toits proximal end. This means that the thread must be much longer than itwould need to be if used only for IUD retrieval or verification. Thus,currently available IUD systems require the physician to insert sterile,sharp scissors or another cutting instrument into the vaginal cavityafter IUD placement and cut the extra-long thread to a useful length forlater IUD retrieval. It is not practical to leave the IUD thread uncut,because it would extend out of the vagina, causing physical discomfortto the user, discomfort during sexual intercourse, significant risk ofinfection, and significant risk of accidental removal of the IUD bypulling on the dangling thread.

Therefore, after an IUD is delivered into the uterus, the IUD insertiondevice is removed from the body, leaving the IUD in the uterus and thelong thread extending through the cervix into the vaginal cavity. Thephysician must then insert sterile scissors into the vaginal cavity tocut the thread to a shorter length, so that the thread still extendsinto the vaginal cavity but does not extend too far into or out of thevaginal cavity. The remaining end portion of the thread then typicallywraps around the cervical fornix.

Although currently available IUD threads work for their intendedpurpose, inserting the IUD requires additional time and the additionalstep of trimming the thread. This step involves inserting scissors orsome other sharp cutting device into the vaginal cavity, which adds timeand potential discomfort to an IUD insertion procedure and increases therisk of accidentally dislodging the IUD from the uterus. In a worst casescenario, the thread cutting step may even cause injury and/or infectionto the patient, due to the required insertion and manipulation of asharp cutting device in the vaginal cavity. Therefore, it would beadvantageous to have an IUD device with an improved thread or otherretrieval mechanism that did not require trimming or other, additionalsteps during an IUD insertion procedure.

BRIEF SUMMARY

Disclosed herein are various embodiments of an improved IUD and IUDinsertion system. Generally, the described embodiments allow an IUD tobe safely and reliably delivered into a uterus without requiring theadditional step of cutting a thread attached to the IUD.

In one aspect, an intrauterine contraceptive system may include acontraceptive intrauterine device, a retrieval thread permanentlyattached to the intrauterine device and having a length of between about5 centimeters and about 9 centimeters, and an insertion device forinserting the intrauterine device into a uterus. The intrauterine devicemay be deployable out of a distal end of the insertion device and may beconfigured to change from a delivery configuration when housed in theinsertion device to a deployed configuration when deployed in a uterus.The retrieval thread may be at least partially housed within theinsertion device during insertion of the intrauterine device into theuterus.

In some embodiments, the system may also include a release threadreleasably coupled with the intrauterine device. The release thread mayextend from the intrauterine device through the insertion device to anattachment point at or near a proximal end of the insertion device. Insome embodiments, the intrauterine device may include an opening, theretrieval thread may be attached to the intrauterine device at or nearthe opening, and the release thread may pass through the opening. Insome embodiments, the release thread may have a length sufficient toallow it to pass from the attachment point through the intrauterinedevice and back to the attachment point.

Optionally, the retrieval thread may include a first portion having afirst color and a second portion having a second color, where the firstand second colors contrast with one another sufficiently to be visibleduring a physical examination of a patient in which the intrauterinedevice has been placed. In some embodiments, the first portion mayextend from a point of attachment of the retrieval thread with theintrauterine device to a location along the retrieval thread betweenabout 2 centimeters and about 3 centimeters from the point ofattachment. In some embodiments, the retrieval thread may include athird portion having the first color, where the second portion is a bandof the second color, with the first and third portions on either side ofthe band.

In another aspect, an intrauterine contraceptive device may include aframe and a retrieval thread permanently attached to the frame andhaving a length of between about 5 centimeters and about 9 centimeters.Optionally, the frame may include an opening, and the retrieval threadmay be attached to the frame at or near the opening. Some embodiments ofthe device may also include a release thread releasably coupled with theframe for coupling the intrauterine device with an insertion device. Insome embodiments, the retrieval thread may include a first portionhaving a first color and a second portion having a second color, wherethe first and second colors contrast with one another sufficiently to bevisible during a physical examination of a patient in which theintrauterine device has been placed. For example, the first portion mayextend from a point of attachment of the retrieval thread with the frameto a location along the retrieval thread between about 2 centimeters andabout 3 centimeters from the point of attachment. Optionally, theretrieval thread may include a third portion having the first color,where the second portion comprises a band of the second color, with thefirst and third portions on either side of the band.

In another aspect, a method for delivering a contraceptive intrauterinedevice into a uterus may involve: advancing a distal end of an insertiondevice through a vaginal cavity and a cervix and into the uterus;advancing the intrauterine device out of the distal end of the insertiondevice, into the uterus, where the intrauterine device is permanentlyattached to a retrieval thread and removably coupled with a releasethread; pulling the release thread off of the intrauterine device; andremoving the release thread and the insertion device from the uterus,leaving the intrauterine device behind in the uterus, without cuttingthe retrieval thread. After delivery of the IUD into the uterus, theretrieval thread extends from an attachment point of the retrievalthread with the intrauterine device through the cervix into the vaginalcavity.

In some embodiments, the method may further involve controllingadvancement of the intrauterine device out of the distal end of theinsertion device, using the release thread. In some embodiments, themethod may also involve manipulating the intrauterine device during orafter advancing it out of the distal end of the insertion device, bymanipulating the release thread. Optionally, pulling the release threadmay involve pulling one end of the release thread, and wherein therelease thread is looped through the intrauterine device. In someembodiments, removing the release thread and the insertion device fromthe uterus may involve removing the release thread first, by pulling itout through the insertion device, and after removing the release thread,pulling the insertion device out of the uterus. Alternatively, removingthe release thread and the insertion device from the uterus may involvepulling the release thread and the insertion device out of the uterustogether, at the same time.

The method may also optionally involve viewing the retrieval thread inthe vaginal cavity after removing the release thread and the insertiondevice from the uterus. For example, the method may include confirmingdelivery of the intrauterine device sufficiently far into the uterus toperform contraception, based on viewing the retrieval thread. Viewingthe retrieval thread may involve, for example, viewing a colored markeron the thread, where the marker is located a known distance from theattachment point of the retrieval thread with the intrauterine device.Alternatively, viewing the retrieval thread may involve viewing a colorchange at a point along the thread, where the point is located a knowndistance from the attachment point of the retrieval thread with theintrauterine device.

These and other aspects and embodiments will be described in furtherdetail below, in reference to the attached drawing figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates an IUD and inserter system, according to oneembodiment;

FIG. 1B illustrates the IUD of FIG. 1A in close-up; and

FIGS. 2A-2E illustrate a method for inserting an IUD, using an IUDinserter device, according to one embodiment.

DETAILED DESCRIPTION

Current IUDs typically include a long, two-string thread, attached tothe distal end of the IUD, extending through the inner sheath of the IUDinserter, and secured at the proximal end of the inserter. This longthread is used to first load the IUD into the distal end of the insertersystem for delivery, then to hold the IUD securely in place at thedistal tip of the inserter until it is placed and released in theuterine space. After IUD delivery in the uterus, the long thread isreleased from the inserter proximal end, and the inserter is withdrawnover the long thread. The clinician must then cut the long thread to alength, typically 3 to 4 cm beyond the external cervical os (the openingof the cervix facing into the vaginal cavity). As discussed above, thisthread cutting step takes time, requires additional sterileinstrumentation, is uncomfortable for the patient, and involves inherentrisks of dislodging the IUD and even injury and infection, as theclinician must insert a sharp cutting device into the vaginal cavity tocut the thread.

The embodiments disclosed in this application provide for an IUD with aretrieval thread having a predetermined length that does not requirecutting after delivery of the IUD into the uterus. Also disclosed hereinis a means for delivering the IUD with the retrieval thread into theuterus. Generally, in the embodiments described herein, the cutretrieval thread is not used to perform the loading and securementfunctions of IUD placement, as with prior art devices, and therefore,the retrieval thread may be made short enough at the time of manufacturesuch that it does not require cutting after IUD delivery into theuterus.

Referring to FIG. 1A, in one embodiment, an IUD system 10 may include anIUD 22 and an inserter 12 (or “inserter device” or “insertion device”).The inserter 12 may include a distal end 14 (into which the IUD 22 isloaded), a proximal end 16, and a handle 18 with a slider 20. Referringto FIG. 1B, the IUD 22 may include a frame 26, a retrieval thread 28,and a release thread 24. In some embodiments, the frame 26 may includean opening 32 at or near a midpoint 30 along the length of the frame 26.This midpoint 30 may also be referred to as the “distal end” of the IUD22, or in other words the end of the IUD 22 that is closest to thecervix when the IUD 22 is delivered to the uterus. The retrieval thread28 is permanently attached to the frame 26, in some embodiments at ornear the midpoint 30 and/or the opening 32. The release thread 24 maypass through the opening 32. Also attached to this embodiment of the IUDare multiple copper sleeves 34. Alternatively, however, the IUD 22 maybe a hormonal IUD, have different copper-carrying members, be ahormone/copper combination device, or not include copper or hormone. Inother words, the two-string configuration described herein may beapplied to any type of IUD, according to various alternativeembodiments.

As just mentioned, the IUD 22 includes a two-thread IUD insertion systemthat allows for the secure delivery of the IUD 22 into the uterus, withan integral retrieval thread 28 that has a predetermined length thatdoes not require cutting after delivery of the IUD. The release thread24 is configured to secure the IUD 22 in the distal end 14 of theinserter 12. Thus, the release thread 24 holds the IUD 22 within theinserter 12 until the IUD 22 is released. In some embodiments, referringagain to Figure IA, the release thread 24 extends from a first end,located outside the proximal end 16 of the inserter 12, through theshaft of the inserter 12, through the IUD 22, and back out of theproximal end 16. By attaching to the proximal end 16 of the inserter 12and releasably attaching to the IUD 22, the release thread 24 may beused to hold onto the IUD 22 as it is unsheathed from the inserter 12,fully opens to its default, expanded shape, and is positioned andpossibly repositioned within the uterus, all before being released forfinal placement. The release thread 24 is releasably coupled with theIUD 22 (not permanently attached), so when it is no longer needed forsecuring the IUD 22 to the inserter 12, the release thread 24 may simplybe pulled off the IUD 22.

The retrieval thread 28 is permanently attached to the frame 26 of theIUD 22 at an attachment point and has a predetermined length (measuredfrom the attachment point with the frame 26 to the ends of the retrievalthread 28) in a range of about 5 cm to about 9 cm, and more ideallyabout 5.5 cm to about 8.8 cm, and even more ideally about 7 cm to about8 cm. In one specific embodiment, the retrieval thread may have a lengthof about 7.8 cm. The predetermined length is selected such that, in thevast majority of patients, the resulting exposed length in the vaginalcavity will be approximately 3-4 cm from the external os of the cervix,as is clinically desirable. With this configuration, the physician willtypically not be required to cut the retrieval thread 28, therebyeliminating a deployment step, saving valuable time, and reducing theuse of instrument resources. The IUD delivery system 10 also reducesrisk of injury and infection to the patient, as the physician does notneed to advance a sharp object or instrument into the vaginal cavityafter IUD deployment for cutting. Additionally, there is less risk ofinadvertent IUD dislodgement and/or removal, which may occur usingcurrently available systems when the scissors do not completely cut thethread and accidentally grasp it and pull on it.

Although the retrieval thread 28 is illustrated in Figure IB (and FIG.2E) as having two strings extending from the IUD 22, alternativeembodiments may have only one string or may have more than two strings.In one alternative embodiment, for example, one end of a retrievalthread may be attached to the IUD 22, and an opposite end may be a freeend, such that retrieval thread includes only one “string.” Inalternative embodiments, a retrieval thread may include three or more“strings.”

Both the retrieval thread 28 and the release thread 24 may be made ofany suitable material, such as but not limited to any monofilament orother suture material currently available or as yet to be invented, orany other biocompatible material that may be used to make a thread orstring. Various embodiments may be coated or uncoated.

In various embodiments, the retrieval thread 28 may also include acolored marker, multiple colored markers, or one or more color changesalong the length of the thread 28. For example, a marker may be placedon the retrieval thread 28 between about 1 cm and about 3 cm (ideallyabout 2 cm) from an attachment point of the thread 28 to the IUD 22. Themarker, markers or color change on the retrieval thread 28 will providesufficient contrast such that a physician will be able to view themarker/color change inside the vaginal cavity after placement of the IUD22. Since the marker or color change is a known distance from theattachment point with the IUD 22, the physician will be able todetermine if the IUD 22 is placed too low within the uterus, or at laterpatient visits, determine that the ID has moved from its originallyplaced position. In some embodiments, the physician may view one or moremarkers inside the vaginal cavity to make the determination. In otherembodiments, the physician may view the retrieval thread 28 and not seea marker, and this inability to view the marker may confirm correctplacement. At later patient visits, the physician may again view themarker or color change to determine if the IUD 22 has displacedinferiorly over time. In various embodiments, the marker(s) and/or colorchange(s) on the retrieval thread 28 may be viewed by the naked eye orby a scope or other viewing device.

The retrieval thread 28 may include markers and/or color changes thathave any suitable color combinations, as long as the color combinationsprovide sufficient contrast to make the change visible to a physician.In one embodiment, for example, a first portion of the retrieval thread28 closest to the IUD 22 may be white, and a second portion at the endof the retrieval thread 28 may be blue. Typically, the marker will besimply a change in color of the retrieval thread 28, rather than anadditional piece or suture, to reduce the risk of debris accumulationand/or infection. Since the length of an average cervix is about 3 cm,positioning the marker less than about 3 cm away from the attachment ofthe retrieval thread 28 to the IUD 22 is preferable in at least someembodiments. Visualization of the marker in the vagina will indicatethat the bottom of the device is within the cervix, which is consideredtoo low for optimal clinical efficacy. In the embodiment in which thefirst portion of the retrieval thread 28 is blue and the second portionis white, for example, the physician may view the thread 28 in thevaginal cavity. If only the second, blue portion of the retrieval thread28 is showing (the end of the thread, in this example), the physicianmay confirm that the IUD 22 is placed sufficiently high in the uterus.If the first, white portion and part of the blue portion of theretrieval thread 28 are showing (the white portion being the portionclosest to the IUD 22, in this example), then the physician maydetermine that the IUD 22 is positioned too low in the uterus.

Low position of an IUD within a uterus is a significant cause of IUDfailure and subsequent pregnancies. Physicians have no currentlyavailable, reliable way to identify a low position, other than using animaging modality, such as ultrasound or x-ray fluoroscopy. Ultrasound isexpensive and typically not readily available in family planningclinics, especially in developing countries. Fluroscopy is even moreexpensive, complicated and time-consuming. Including a marker on theretrieval thread 28 will allow a physician to identify low positioneasily during routine examination of the cervix performed in thegynecologist office.

With reference now to FIGS. 2A-2E, one embodiment of a method for usingthe IUD system 10 described in relation to Figures IA and IB will now bedescribed. In various alternative embodiments, one or more of the stepsdescribed here may be altered or skipped, and/or the order of the stepsmay be changed, without departing from the scope of the invention.Therefore, the following description should not be interpreted aslimiting the method as it is described in the claims.

As illustrated in FIG. 2A, a first step of an IUD insertion method mayinvolve advancing the inserter 12 through the vaginal cavity V and thecervix C to position the distal end 14 of the inserter 12 in the uterusU. During advancement of the distal end 14 into the uterus U, the IUD 22is typically housed completely, or mostly, within the inserter 12. Inalternative embodiments, however, a portion, or all, of the IUD 22 mayprotrude out of the distal end 14 during advancement.

Referring to FIG. 2B, a next step may involve sliding the slider 20 ofthe inserter 12 proximally (solid arrow on figure), relative to thehandle 18, to cause the IUD 22 to advance out of the distal end 14 ofthe inserter 12 by uncovering the IUD 22. In alternative embodiments,the inserter 12 may include other mechanisms for advancing the IUD 22out of the distal end 14, such as by advancing the slider 20 when itattached to a movable inner member, thereby pushing the IUD 22 out ofthe inserter 12. During this phase of the method, the IUD 22 does nottouch the top (or “fundus”) of the uterus U.

FIG. 2C illustrates an optional step of advancing the inserter 12farther into the uterus U to contact the IUD 22 with the fundus of theuterus U. This step is optional, because the IUD 22 may alternatively bereleased lower in the uterus U and allowed to move up the uterus U as itexpands.

With reference to FIG. 2D, the method may next involve removing theproximal end 16, which in this embodiment is a cap, from the inserter12. This proximal end 16 cap, while it is attached to the inserter 12,serves to hold and lock onto the release thread 24 to the inserter 12.When the proximal end 16 cap is removed, the release thread 24 is freeto be pulled off of the IUD 22. In various alternative embodiments, anysuitable locking mechanism may be used for holding and then releasingthe release thread 24 at the proximal end 16 of the inserter 12.

Finally, referring to FIG. 2E, once the release thread 24 is releasedfrom its attachment to the proximal end 16 of the inserter 12, so thatit can be pulled off of the IUD 22, the release thread 24 and theinserter 12 may be removed from the patient. In various embodiments,this removal step may be accomplished by pulling the inserter 12 andrelease thread 24 out together, or alternatively by pulling out onefirst and then the other. After the inserter 12 and removal thread 24are removed, the IUD 22 remains in the uterus U, with the retrievalthread 28 extending through the cervix C into the vaginal cavity V.Typically, the retrieval thread 28 will not need to be cut or shortenedin any way. In this embodiment, the retrieval thread 28 includes a firstportion, having a first length 36 and a first color, and a secondportion, having a second length 38 and a second color. As describedabove, the overall length of the retrieval thread 28 will typically bebetween about 5 cm and about 9 cm, as measured from the attachment pointto the ends of the two strings (length 36 plus length 38). The firstlength 36 will typically be about 3 cm or less, and may be about 2 cm orless. The second length may be between about 3 cm and about 4 cm in someembodiments. As mentioned above, in alternative embodiments, theretrieval thread 28 may include one string or three or more strings,rather than two strings, as pictured in in FIG. 2E. In one embodiment,the first portion of the retrieval thread 28 may be white, and thesecond portion may be blue, although any alternative color combinationor marker combination may alternatively be used. Once the IUD 22 isdelivered, the physician may view the retrieval string 28 in the vaginalcavity. If only blue thread is visible, the physician may conclude thatthe IUD is sufficiently far into the uterus U. If white thread isvisible, the physician may conclude that the IUD is too low in theuterus U.

Although various embodiments and features are described herein, thepresent invention extends beyond the specifically disclosed embodimentsto other alternative embodiments and/or uses of the invention andobvious modifications and equivalents thereof. Thus, the scope of thepresent invention herein disclosed should not be limited by theparticular disclosed embodiments described above.

What is claimed is:
 1. An intrauterine contraceptive system, comprising:an inserter; and an intrauterine device, configured to change from adelivery configuration to an expanded configuration when released fromconstraint within a uterus, the intrauterine device comprising: a wireframe, comprising: a distal end; two arms extending laterally; and atwist portion between the distal end and the two arms; one or moresubstance delivery members coupled with the wire frame; a retrievalthread permanently attached to the distal end of the wire frame forremoving the intrauterine device from the uterus, wherein the retrievalthread has a length such that the retrieval thread does not requirecutting after the intrauterine device is delivered into the uterus; anda release thread releasably attached to the distal end of the wireframe, for coupling the intrauterine device with the insertion device,so that when the release thread is no longer needed for securing theintrauterine device to the insertion device, the release thread may bepulled off the intrauterine device.
 2. A system as in claim 1, whereinthe length of the retrieval thread is between 5 centimeters and 9centimeters.
 3. A system as in claim 1, wherein the retrieval thread isat least partially housed within the insertion device during insertionof the intrauterine device into the uterus.
 4. A system as in claim 1,wherein the one or more substance delivery members are selected from thegroup consisting of copper sleeves, copper wires, hormone deliverysleeves, drug delivery depots, drug coatings, and drug eluting carriers.5. A system as in claim 1, wherein the one or more delivery members arecoupled with the wire frame near two ends of the two arms and near thedistal end, below the twist portion.
 6. A system as in claim 1, whereinat least one of the retrieval thread or the release thread comprises: afirst portion having a first color; and a second portion having a secondcolor, wherein the first and second colors contrast with one anothersufficiently to be visible during a physical examination of a patient inwhich the intrauterine device has been placed.
 7. A system as in claim6, wherein the first portion extends from a point of attachment of theretrieval thread or the release thread with the intrauterine device to alocation along the retrieval thread or the release thread between 2centimeters and 3 centimeters from the point of attachment.
 8. A systemas in claim 6, wherein at least one of the retrieval thread or therelease thread further comprises a third portion having the first color,wherein the second portion comprises a band of the second color, withthe first and third portions on either side of the band.
 9. The systemof claim 1, wherein a substance carried and delivered by the one or moresubstance delivery members is selected from the group consisting ofcopper, Levonorgestrel, other hormones, and other spermicidal agents.10. An intrauterine contraceptive device, comprising: a frame configuredto change from a delivery configuration to an expanded configurationwhen released from constraint within a uterus, the frame comprising: adistal end; two arms extending laterally; and a twist portion betweenthe distal end and the two arms; one or more hormone delivery memberscoupled with the frame; a retrieval thread permanently attached to thedistal end of the frame for removing the intrauterine device from theuterus, wherein the retrieval thread has a length such that theretrieval thread does not require cutting after the intrauterine deviceis delivered into the uterus; and a release thread releasably attachedto the distal end of the frame, for coupling the intrauterine devicewith the insertion device, so that when the release thread is no longerneeded for securing the intrauterine device to an insertion device, therelease thread may be pulled off the intrauterine device.
 11. A deviceas in claim 10, wherein the length of the retrieval thread is between 5centimeters and 9 centimeters.
 12. A device as in claim 10, wherein theone or more hormone delivery members deliver Levonorgestrel.
 13. Adevice as in claim 10, wherein the one or more hormone delivery membersare selected from the group consisting of drug delivery depots, drugcoatings, and drug eluting carriers.
 14. A device as in claim 13,wherein the one or more hormone delivery members comprise a drug elutingcarrier containing, coated or impregnated with Levonorgestrel.
 15. Adevice as in claim 14, wherein the drug eluting carrier is disposed overthe twist portion between the distal end and the two arms.
 16. A deviceas in claim 10, further comprising at least one copper member coupledwith the frame, wherein the at least one copper member is selected fromthe group consisting of copper wires and copper sleeves.
 17. A device asin claim 10, wherein the frame comprises an elongate shape memory wiremade of a material selected from the group consisting of Nitinol, springstainless steel, other shape memory metal alloys, and shape memorypolymers.
 18. A device as in claim 17, wherein a first end of a firstarm of the two arms of the frame comprises a first loop, and wherein asecond end of a second arm of the two arms comprises a second loop. 19.The device of claim 18, further comprising: a first sleeve fixedlyattached to the first end of the elongate shape memory wire to form thefirst loop; and a second sleeve fixedly attached to the second end ofthe elongate shape memory wire to form the second loop.